Introduction In hospitalised patients, fluid resuscitation is the second commonest intervention after oxygen administration. The situation becomes complex when fluids are prescribed to patients on parenteral nutrition (TPN), as TPN contributes to their fluid requirements. Excess IV fluids can cause complications such as fluid overload in sick patients with multiple co-morbidities.
Method The aim of the study was to assess the appropriateness of additional IV fluid therapy in patients receiving TPN at our hospital. We prospectively reviewed patients receiving TPN for 3 months from October to December 2014. We used dietitian’s charts, medical notes and drug charts to gather data, which included indications, amount and type of additional fluids given and fluid balance. We also noted whether there were any complications such as fluid overload. The data included patient gender, age and whether a medical or surgical team looked after them. Additional fluids were described as appropriate if given for renal impairment or to match the fluid balance e.g. insensible or extra losses.
Results A total of thirty patients were given TPN during the three months. Age range was 35–90 with an average age of 58. There were equal number of male and female patients. 22 (73%) patients were managed on surgical wards, the remainder on medical wards. 26 (86%) patients were prescribed additional IV fluids during their admission.
Indications for fluids were not documented in 24/26 (92%). 15 patients were in a positive fluid balance of at least 2 litres over an average duration of 3 days. Of these, 10 patients had renal impairment, which subsequently improved. 4 patients had IV fluids prescribed to compensate for fluid losses e.g. from a high stoma output. 14/26 (53%) fluid prescriptions were appropriate. The choice of fluids was variable as most patients had a mixture of fluids, approximately 50% given at least one litre dextrose as fluids. All of the fluid prescriptions were made by the house officers.
Two patients developed fluid overload requiring diuretics. There were 2 deaths unrelated to fluid management but secondary to the underlying conditions.
Conclusion The results demonstrate that additional IV fluid prescription was often poorly managed. The indication for fluids was not documented in most cases and the choice and volume of fluids were often inappropriate. This is particularly relevant in TPN patients as more dextrose can increase the caloric burden.
We propose that a multidisciplinary nutrition team should take the lead in advising about fluid management as well as TPN and only experienced practitioners should prescribe fluids in these scenarios. Juniors prescribing additional fluids should be supervised or advised.
Disclosure of interest None Declared.